Our purpose is to increase knowledge about the psychosocial impact of contraceptive sterilization on women by using a prospective controlled design to study the sequelae of sterilization. The study will follow the protocol used in a large transnational collaborative study conducted under the auspices of the World Health Organization. The comparison group will consist of similar women who are seeking advice about non-surgical contraceptive methods. Postpartum and interval sterilization will be distinguished. Half of the women in each group will receive sterilization or contraceptive advice in connection with a birth, and the other half will have had no obstetrical event within the past six months. To avoid confounding the effects of sterilization with the effects of abortion, women who are receiving sterilization in connection with an abortion will not be eligible. The impact of sterilization on mental health will be assessed with an abbreviated version of the Present State Examination (PSE). This instrument is designed for use in community surveys, has adequate psychometric properties, and has been used successfully in several countries including the United States. Retrospective estimates of changes in sexual functioning and marital adjustment will be supplemented with more direct measures of pretest-posttest change. The possibility that the psychosocial context and impact of sterilization is different for Black and other women will be examined. The utilization of female sterilization is notably high in the Black population of the United States, and the presence of a substantial Black population in Alabama facilitates the study of this issue.